Systems and methods for prostate treatment

ABSTRACT

A vapor delivery needle is provided that may include any of a number of features. One feature of the energy delivery probe is that it can apply condensable vapor energy to tissue, such as a prostrate, to shrink, damage, denaturate the prostate. In some embodiments, the vapor delivery needle can be advanced a predetermined distance into the prostate by an actuation mechanism. The actuation mechanism can comprise, for example, a spring, or at least one magnet. Methods associated with use of the energy delivery probe are also covered.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.14/241,977, filed Jun. 10, 2014, now U.S. Pat. No. 9,895,185, whichapplication is the national stage under 35 USC 371 of InternationalApplication No. PCT/US2012/055164, filed Sep. 13, 2012, whichapplication claims the benefit of U.S. Provisional Application No.61/534,053, filed Sep. 13, 2011.

INCORPORATION BY REFERENCE

All publications, including patents and patent applications, mentionedin this specification are herein incorporated by reference in theirentirety to the same extent as if each individual publication wasspecifically and individually indicated to be incorporated by reference.

FIELD

The present invention relates to devices and related methods fortreatment of benign prostatic hyperplasia using a minimally invasiveapproach.

BACKGROUND

Benign prostatic hyperplasia (BPH) is a common disorder in middle-agedand older men, with prevalence increasing with age. At age 50, more thanone-half of men have symptomatic BPH, and by age 70, nearly 90% of menhave microscopic evidence of an enlarged prostate. The severity ofsymptoms also increase with age with 27% of patients in the 60-70 agebracket having moderate-to-severe symptoms, and 37% of patients in their70's suffering from moderate-to-severe symptoms.

The prostate early in life is the size and shape of a walnut and priorto the enlargement resulting from BPH, weighs about 20 grams. Prostateenlargement appears to be a normal process. With age, the prostategradually increases in size to twice or more its normal size. Thefibromuscular tissue of the outer prostatic capsule restricts expansionafter the gland reaches a certain size. Because of such restriction onexpansion, the intracapsular tissue will compress against and constrictthe prostatic urethra, thus causing resistance to urine flow.

FIG. 1 is a sectional schematic view the male urogenital anatomy, withthe walnut-sized prostate gland 100 located below the bladder 105 andbladder neck indicated at 106. The walls 108 of bladder 105 can expandand contract to cause urine flow through the urethra 110, which extendsfrom the bladder 105, through the prostate 100 and penis 112. Theportion of urethra 110 that is surrounded by the prostate gland 100 isreferred to as the prostatic urethra 120. The prostate 100 alsosurrounds the ejaculatory ducts 122 which have an open termination inthe prostatic urethra 120. During sexual arousal, sperm is transportedfrom the testes 124 by the ductus deferens 126 to the prostate 100 whichprovides fluids that combine with sperm to form semen duringejaculation. On each side of the prostate, the ductus deferens 126 andseminal vesicles 128 join to form a single tube called an ejaculatoryduct 122. Thus, each ejaculatory duct 122 carries the seminal vesiclesecretions and sperm into the prostatic urethra 120.

Referring to FIGS. 2A-2C, the prostate glandular structure can beclassified into three zones: the peripheral zone, transition zone, andcentral zone. The peripheral zone PZ, which is the region forming thepostero-inferior aspect of the gland, contains 70% of the prostateglandular elements in a normal prostate (FIGS. 2A-2C). A majority ofprostate cancers (up to 80%) arise in the peripheral zone PZ. Thecentral zone CZ surrounds the ejaculatory ducts 122 and contains about20-25% of the prostate volume. The central zone is often the site ofinflammatory processes. The transition zone TZ is the site in whichbenign prostatic hyperplasia develops, and contains about 5-10% of thevolume of glandular elements in a normal prostate (FIG. 2C), but canconstitute up to 80% of such volume in cases of BPH. The transition zoneTZ consists of two lateral prostate lobes and the periurethral glandregion indicated at 130. As can be understood from FIGS. 2A-2C, thereare natural barriers around the transition zone TZ, i.e., the prostaticurethra 120, the anterior fibromuscular stroma FS, and a fibrous planeFP between the transition zone TZ and peripheral zone PZ. In FIGS.2A-2C, the anterior fibromuscular stroma FS or fibromuscular zone can beseen and is predominantly fibromuscular tissue.

BPH is typically diagnosed when the patient seeks medical treatmentcomplaining of bothersome urinary difficulties. The predominant symptomsof BPH are an increase in frequency and urgency of urination, and asignificant decrease in the rate of flow during urination. BPH can alsocause urinary retention in the bladder which in turn can lead to lowerurinary tract infection (LUTI). In many cases, the LUTI then can ascendinto the kidneys and cause chronic pyelonephritis, and can eventuallylead to renal insufficiency. BPH also may lead to sexual dysfunctionrelated to sleep disturbance or psychological anxiety caused by severeurinary difficulties. Thus, BPH can significantly alter the quality oflife with aging of the male population.

BPH is the result of an imbalance between the continuous production andnatural death (apoptosis) of the glandular cells of the prostate. Theoverproduction of such cells leads to increased prostate size, mostsignificantly in the transition zone which traverses the prostaticurethra.

In early stage cases of BPH, pharmacological treatments can alleviatesome of the symptoms. For example, alpha-blockers treat BPH by relaxingsmooth muscle tissue found in the prostate and the bladder neck, whichmay allow urine to flow out of the bladder more easily. Such drugs canprove effective until the glandular elements cause overwhelming cellgrowth in the prostate.

More advanced stages of BPH, however, can only be treated by surgical orless-invasive thermal ablation device interventions. A number of methodshave been developed using electrosurgical or mechanical extraction oftissue, and thermal ablation or cryoablation of intracapsular prostatictissue. In many cases, such interventions provide only transient relief,and these treatments often cause significant peri-operative discomfortand morbidity.

In a prior art thermal ablation method, RF energy is delivered toprostate tissue as schematically depicted in FIGS. 3A-3B. FIG. 3Adepicts the elongated prior art RF needle being penetrated into aplurality of locations in a prostate lobe. In a first aspect of theprior art method, the elongated RF needle typically is about 20 mm inlength, together with an insulator that penetrates into the lobe. Theresulting RF treatment thus ablates tissue away from the prostaticurethra 120 and does not target tissue close to, and parallel to, theprostatic urethra 120. In another aspect of the prior art RF thermalablation method, the application of RF energy typically extends for 1 to3 minutes or longer which allows thermal diffusion of the RF energy toablate tissue out to the capsule periphery. Such prior art RF energydelivery methods may not create a durable effect, since smooth muscletissue and alpha adrenergic receptors are not uniformly ablated aroundthe prostatic urethra or within the transition zone. As a result, tissuein the prostate lobes can continue to grow and impinge on the urethrathus limiting long-term effectiveness of the treatment.

SUMMARY OF THE DISCLOSURE

According to the embodiments described above, a prostate treatmentdevice can be provided comprising an introducer shaft sized andconfigured for transurethral access into a patient, a vapor generatorconfigured to generate a condensable vapor, a vapor delivery needle incommunication with the vapor generator and slidably disposed within theintroducer shaft, and a magnetic actuator configured to apply magneticforce to the vapor delivery needle to move the vapor delivery needlebetween a retracted position inside the introducer shaft and an extendedposition at least partially outside of the introducer shaft.

In some embodiments, the magnetic actuator is configured to axially movethe vapor delivery needle toward the extended position from theretracted position at a velocity ranging from 0.1 meter per second to20.0 meters per second. In another embodiment, the vapor delivery needlecan move between the retracted and extended positions (and vice versa)at a velocity ranging from 1 meter per second to 5 meters per second.

In other embodiments, the magnetic actuator is configured to cause a tipportion of the vapor delivery needle to penetrate into prostate tissuewhen moving toward the extended position from the retracted position. Insome embodiments, the vapor delivery needle is sized and configured toextend into prostate tissue when the introducer shaft is positionedwithin a urethra of the patient.

In one embodiment, the magnetic actuator further comprises a firstmagnet carried by the vapor delivery needle, wherein the magneticactuator is configured to move the first magnet and the vapor deliveryneedle proximally and distally along a longitudinal axis of theintroducer shaft. In another embodiment, the magnetic actuator furthercomprises a second magnet carried in a frame of a handle of the device,the second magnet being configured to interact with the first magnet tomove the vapor delivery needle proximally and distally along thelongitudinal axis of the introducer shaft. In some embodiments, theframe is rotatable in the handle. In yet another embodiment, themagnetic actuator further comprises a third magnet carried in a secondframe of the handle, the third magnet being configured to interact withthe first and second magnets to move the vapor delivery needleproximally and distally along the longitudinal axis of the introducershaft.

In some embodiments, the device can further include a grip adapted formanual control of the magnetic actuator to move the vapor deliveryneedle between the retracted position and the extended position. Inanother embodiment, the device comprises a gear rack coupled to thegrip, the gear rack being configured to rotate the frame and the secondmagnet so as to engage or disengage from the first magnet.

In some embodiments, the device can comprise a lock configured to lockthe vapor delivery needle in the retracted position. The device canfurther comprise a trigger adapted to release the lock to thereby movethe vapor delivery needle to the extended position from the retractedposition.

In one embodiment, the magnetic actuator is configured to apply asuitable magnetic force to cause the tip portion of the vapor deliveryneedle to withdraw from prostate tissue when moving to the retractedposition. In some embodiments, the suitable magnetic force can rangefrom 1 to 3 pounds of force during advancement and retraction. In oneembodiment, the force can be at least 2 pounds of force.

In some embodiments, the device can further include a vapor actuator foractuating a flow of condensable vapor through the vapor delivery needle.The device can further comprise an interlock mechanism which permitsactuation of the vapor actuator only if a releasable lock has beenreleased.

In some embodiments, the magnetic actuator comprises at least one rareearth magnet. In other embodiments, the magnetic actuator comprises atleast one neodymium or neodymium-iron-boron magnet.

In one embodiment, the magnetic actuator orients first and secondmagnets relative to one another to utilize repelling forces to move thevapor delivery needle along a longitudinal axis of the introducer shaft.In another embodiment, the magnetic actuator orients first and secondmagnets relative to one another to utilize attracting forces to move thevapor delivery needle along a longitudinal axis of the introducer shaft.In some embodiments, the magnetic actuator orients first and secondmagnets relative to one another to utilize attracting and repellingforces to move the vapor delivery needle along a longitudinal axis ofthe introducer shaft.

A method of treating prostate tissue is also provided, comprisinginserting a shaft of a prostate therapy device transurethrally until aworking end of the shaft is proximate to the prostate tissue, actuatinga magnetic assembly to advance a vapor delivery needle from theintroducer into the prostate tissue, and delivering condensable vaporfrom the vapor delivery needle into the prostate tissue.

In some embodiments, the condensable vapor provides a thermal effect inthe prostate tissue.

In one embodiment, the vapor delivery needle advances into the prostatetissue under the influence of repelling forces between first and secondmagnets of the magnetic assembly. In another embodiment, the vapordelivery needle advances into the prostate tissue under the influence ofattracting forces between first and second magnets of the magneticassembly. In some embodiments, the vapor delivery needle advances intothe prostate tissue under the influence of attracting and repellingforces between first and second magnets of the magnetic assembly.

A prostate treatment device is also provided, comprising an introducershaft sized and configured for transurethral access into a patient, avapor generator configured to generate a condensable vapor, a vapordelivery needle in communication with the vapor generator and slidablydisposed within the introducer shaft, and an actuation mechanismconfigured to apply force to move a distal portion of the vapor deliveryneedle from a retracted position inside the introducer shaft to anextended position outside of the introducer shaft.

In some embodiments, the actuation mechanism moves a distal tip of thevapor delivery needle outward from the introducer shaft a distance ofless than 2 cm.

In another embodiment, the device comprises a controller configured todeliver a selected volume of condensable vapor through the needle thatcarries less than 240 calories of energy.

In some embodiments, the actuation mechanism comprises a spring. Inother embodiments, the actuation mechanism comprises at least onemagnet. In one embodiment, the actuation mechanism is configured to movethe vapor delivery needle toward the extended position from theretracted position at a velocity ranging from 0.1 meter per second to20.0 meters per second.

In one embodiment, the vapor delivery needle is sized and configured toextend into prostate tissue when the introducer shaft is positionedwithin a urethra of the patient.

In some embodiments, the actuation mechanism comprises a first magnetcarried by the vapor delivery needle. In another embodiment, theactuation mechanism comprises a second magnet carried in a frame of ahandle of the device, the second magnet being configured to interactwith the first magnet to move the vapor delivery needle. In someembodiments, the frame is rotatable in the handle.

In some embodiments, the device can further include a grip adapted formanual control of the magnetic actuator to move the vapor deliveryneedle between the retracted position and the extended position. Inanother embodiment, the device comprises a gear rack coupled to thegrip, the gear rack being configured to rotate the frame and the secondmagnet so as to engage or disengage from the first magnet.

In some embodiments, the device can comprise a lock configured to lockthe vapor delivery needle in the retracted position. The device canfurther comprise a trigger adapted to release the lock to thereby movethe vapor delivery needle to the extended position from the retractedposition.

In some embodiments, the device can further include a vapor actuator foractuating a flow of condensable vapor through the vapor delivery needle.The device can further comprise an interlock mechanism which permitsactuation of the vapor actuator only if a releasable lock has beenreleased.

A method of treating prostate tissue is provided, comprising inserting ashaft of a prostate therapy device transurethrally until a working endof the shaft is proximate to the prostate tissue, advancing a vapordelivery needle from the introducer into at least one site in prostatetissue to a depth of less than 2 cm, and delivering condensable vaporfrom the vapor delivery needle into the prostate tissue.

In some embodiments, the condensable vapor provides a thermal effect inthe prostate tissue. In other embodiments, the condensable vapordelivers less than 240 calories of energy at each site.

In one embodiment, the vapor delivery needle advances into the prostatetissue under forces applied by a spring. In another embodiment, thevapor delivery needle advances into the prostate tissue under theinfluence of at least one magnet.

BRIEF DESCRIPTION OF THE DRAWINGS

In order to better understand the invention and to see how it may becarried out in practice, some preferred embodiments are next described,by way of non-limiting examples only, with reference to the accompanyingdrawings, in which like reference characters denote correspondingfeatures consistently throughout similar embodiments in the attacheddrawings.

FIG. 1 is a sectional schematic view the male urogenital anatomy.

FIGS. 2A, 2B and 2C are views of a patient's prostate showing zones ofprostate tissue.

FIG. 3A is a sectional view of a normal prostate gland.

FIG. 3B is a sectional view of a prostate gland with BPH.

FIG. 4 is a perspective view of a probe corresponding to the invention.

FIG. 5 is a view of components within a handle portion of the probe ofFIG. 4.

FIG. 6 is another view of components within a handle portion of theprobe of FIG. 4.

FIG. 7 is a cross sectional view of a probe.

FIG. 8 is a side view of a microcatheter or needle of a probe.

FIG. 9 is a side elevation view of the microcatheter or a vapor deliveryneedle of the probe of FIG. 4 showing its dimensions and vapor outlets.

FIG. 10 is another view of the microcatheter of FIG. 9.

FIG. 11 is another view of a distal portion of the microcatheter of FIG.10.

FIG. 12 is a sectional view of the microcatheter of FIG. 10 taken alongline 11-11 of FIG. 10.

FIGS. 13A-13B are schematic views of the probe of FIG. 4 in a head-onview in a prostate indicating the radial angle of the probe as it isrotated in situ to treat lateral prostate lobes.

FIGS. 14A-14B are schematic views similar to that of FIGS. 13A-13Bshowing a method of rotating certain components of the probe againindicating the radial angles of the penetrating microcatheter of theprobe of FIG. 4, while leaving the probe handle in a non-rotatedposition.

FIGS. 15A-15B are schematic views similar to that of FIGS. 13A-13Bshowing a method of rotating other components of the probe, againindicating the radial angles of the penetrating microcatheter in thelateral lobes of the prostate while leaving the probe handle in anon-rotated position.

FIG. 16A is a longitudinal sectional schematic view showing a method ofthe invention in treating a prostate for BPH.

FIG. 16B is a transverse sectional view of the prostate of FIG. 16A.

FIG. 17 is another longitudinal sectional view showing ablation zones inthe method of treating a prostate for BPH.

FIG. 18 is an MRI from a patient 1 week after a treatment as indicatedschematically in FIGS. 16A-17.

FIG. 19 is a block diagram of a method corresponding to the invention.

FIG. 20 is a block diagram of another method corresponding to theinvention.

FIG. 21 is a block diagram of another method corresponding to theinvention.

FIG. 22 is a perspective view of another embodiment of probecorresponding to invention that delivers vapor for treating BPH.

FIG. 23 is another perspective view of the probe of FIG. 22.

FIG. 24 is a sectional view of the handle of the probe of FIG. 22.

FIG. 25 is another sectional view of the handle of the probe of FIG. 22showing components of a magnetic needle actuator system.

FIG. 26 is another sectional view of the handle of FIGS. 24-25 from adifferent angle.

FIG. 27 is another sectional view of the handle of FIGS. 24-26 from adifferent angle.

FIG. 28 is an exploded view of components of a magnetic needle actuatorsystem as in the handle of FIGS. 24-26.

FIG. 29 is a sectional view of the distal working end of the probe ofFIGS. 22-23.

FIG. 30 is a cut-away view of the introducer portion of the probe ofFIGS. 22-23.

DETAILED DESCRIPTION OF THE INVENTION

In general, one method of the invention for treating BPH comprisesintroducing a heated vapor interstitially into the interior of aprostate, wherein the vapor controllably ablates prostate tissue. Thismethod can utilize vapor for applied thermal energy of between 50calories and 300 calories per each individual vapor treatment (andassumes multiple treatments for each prostate lobe) in an office-basedprocedure. The method can cause localized ablation of prostate tissue,and more particularly the applied thermal energy from vapor can belocalized to ablate tissue adjacent the urethra without damagingprostate tissue that is not adjacent the urethra.

The present invention is directed to the treatment of BPH, and moreparticularly for ablating transitional zone prostate tissue withoutablating central or peripheral zone prostate tissue.

In one embodiment, the present invention is directed to treating aprostate using convective heating in a region adjacent the prostaticurethra.

In one embodiment, the method of ablative treatment is configured totarget smooth muscle tissue, alpha adrenergic receptors, sympatheticnerve structures and vasculature parallel to the prostatic urethrabetween the bladder neck region and the verumontanum region to a depthof less than 2 cm.

In one embodiment, the system includes a vapor delivery mechanism thatdelivers vapor media, including vapor media. The system can utilize avapor source configured to provide vapor having a temperature of atleast 60° C., 80° C., 100° C., 120° C., or 140° C.

In another embodiment, the system further comprises a computercontroller configured to deliver vapor for an interval ranging from 1second to 30 seconds.

In another embodiment, the system further comprises a source of apharmacologic agent or other chemical agent or compound for deliverywith the vapor. These agents include, without limitation, an anesthetic,an antibiotic or a toxin such as Botox®, or a chemical agent that cantreat cancerous tissue cells. The agent also can be a sealant, anadhesive, a glue, a superglue or the like.

Another method of the invention provides a treatment for BPH that canuse a transrectal or transperineal approach using a transrectalultrasound system (TRUS) as an imaging means to image the prostate, andnavigate a vapor delivery tool to the targeted treatment sites.

In another method of the invention, the tool or vapor delivery needleworking end can be advanced manually or at least in part by a springmechanism.

In another aspect of the invention, the system may contemporaneouslydeliver cooling fluids to the urethra during an ablation treatment toprotect the interior lining of the urethra.

FIGS. 4, 5 and 6 depict one embodiment of probe 100 of the system of theinvention that is adapted for trans-urethral access to the prostrate andwhich provides viewing means to view the urethra as the probe isnavigated to a site in the interior of the patient's prostate. The probe100 further carries an extendable and retractable microcatheter member105 (FIGS. 5-6) having a distal tip portion 108 (FIG. 4) that can bepenetrated into precise targeted locations in prostate lobes to ablatetargeted tissue volumes.

Handle and Introducer Portion

In FIG. 4, it can be seen that probe 100 has an elongate introducerportion 110 for insertion into the urethra and a handle portion 111 forgripping with a human hand. The key structural component of introducerportion 110 comprises a rigid introducer sleeve or extension sleeve 112extending along longitudinal axis 113 with proximal end 114 a and distalend 114 b. The bore 115 in the rigid extension sleeve extends alonglongitudinal axis 116. In one embodiment, referring to FIGS. 4 and 5,the extension sleeve 112 comprises a thin-wall stainless steel tube withbore 115 dimensioned to receive a commercially available viewing scopeor endoscope 118. The schematic cut-away view of FIG. 5 shows structuralbulkhead 120 coupled to a medial portion 122 of extension sleeve 112.The structure or bulkhead 120 comprises the structural member to whichthe molded handle having pistol grip 124, and more particularly theright- and left-side mating handle parts, 125 a and 125 b, are coupled(FIG. 4). The bulkhead can be a plastic molded part that can be fixed tosleeve 112 or rotationally coupled to sleeve 112.

Referring to FIGS. 5-6, in which the molded handle left and right sidesare not shown, it can be seen that bore 115 in sleeve 112 has a proximalopen end 130 into which the endoscope 118 can be inserted. The proximalend portion 114 a of extension sleeve 112 is coupled to an adaptermechanism 132 that releasably engages the endoscope 118 and rotationallyaligns the scope 118 with the introducer portion 110. The endoscope 118has a proximal viewing end 135 and light connector 136 extending outwardfrom the viewing end 136 for coupling a light source 140 to theendoscope. FIG. 7 illustrates that bore 115 in sleeve 112 has a diameterranging from about 2 to 5 mm for accommodating various endoscopes 118,while at the same time providing an annular space 138 for allowing anirrigation fluid to flow through bore 115 and outwardly from theintroducer portion.

In one embodiment of system 100, referring to FIGS. 5-8, theextendable-retractable microcatheter 105 comprises a thin-wall flexiblepolymer tube with a sharp tip that is axially slidable in a passageway148 in the introducer portion 110. FIGS. 4, 7 and 9 show that theintroducer portion 110 comprises an elongate introducer body 144 ofplastic or another suitable material that surrounds extension sleeve112. The introducer body 144 extends to a distal working end portion 145having a blunt nose or tip 146 for advancing through the urethra. Theelongate introducer body 144 is further configured with passageway 148that accommodates the microcatheter member 105 as will be describedbelow. Referring to FIGS. 8-9, the distal end portion 145 of theintroducer body 144 is configured with openings 160 that open to centralopen region 162 that is distal to the distal lens 164 of endoscope 118that allows for viewing of the urethra through the lens 164 of theendoscope during navigation. The endoscope 118 can have a lens with a30°, 12.5° or other angle for viewing through openings 160. As can beseen in FIGS. 8-9, the openings 160 have bridge elements 165therebetween that function to prevent tissue from falling into centralopen region 162 of the introducer body 144. In FIG. 8, it can be seenthat the working end portion 105 of the flexible microcatheter shaft 105is disposed adjacent to open region 162 and thus can be viewed throughthe endoscope lens 164.

Microcatheter and Spring-Actuator

FIGS. 10-11 show the flexible microcatheter member or needle 105de-mated from the probe 100 to indicate its repose shape. In oneembodiment, the microcatheter 105 has a first (proximal) largercross-section portion 170 that necks down to second (distal)cross-section portion 175 wherein the smaller cross-section portion 175has a curved repose shape with the curve configured to conform withoutsignificant resistance to the contour of the curved axis 177 of the pathfollowed by the working end 108 of the microcatheter 105 as it is movedfrom its non-extended position to its extended position as shown inFIGS. 1, 8 and 9. In one embodiment, referring to FIGS. 10-12, themicrocatheter's first cross section portion 170 comprises a thin wallouter sleeve 180 that is concentrically outward from inner microcathetertube 185 that extends the length of the microcatheter member 105. As canbe seen in FIG. 12, the outer sleeve 180 provides a thermally insulativeair gap 188 around inner tubular member 185. In one embodiment showndepicted in FIG. 12, the outer sleeve 180 is configured withintermittent protrusions 190 that maintain the air gap 188 between theinner surface 192 of outer sleeve 180 and outer surface 193 of innermicrocatheter tube. FIG. 9 shows that the outer sleeve 180 has neckeddown portion 194 that is bonded to inner microcatheter tube 185 by anysuitable means such as ultrasonic bonding, adhesives or the like.Referring back to FIG. 10, both the outer sleeve 180 and inner tubularmember can comprise a high-temperature resistant polymer such as Ultem®that is suited for delivering a high temperature vapor as will bedescribed below. In one embodiment, the microcatheter tube 185 has anoutside diameter of 0.050″ with an interior lumen 195 of approximately0.030″. Referring to FIGS. 8-9, one embodiment of working end portion108 for delivering vapor media to tissue has a thin wall 198 with aplurality of outlet ports 200 therein that are configured for emitting avapor media into tissue as will be described below. The outlet ports canrange in number from about 2 to 100, and in one embodiment consist of 12outlets each having a diameter of 0.008″ in six rows of two outlets withthe rows staggered around the working end 108 as shown in FIG. 10. Inone embodiment shown in FIGS. 10-11, the distalmost tip 202 of themicrocatheter tube 185 has a sharpened conical configuration that can beformed of the plastic material of tube 185. As will be described below,it has been found that a polymeric needle and needle tip 202 is usefulfor its thermal characteristics in that its heat capacity will notimpinge on vapor quality during vapor delivery.

FIGS. 10-11 further illustrate that the distal tip portion 108 ofmicrocatheter tube 185 has at least one marking 204 that contrasts withthe color of the microcatheter tube 185 that is adapted for viewingthrough lens 164 of the endoscope 118. In one embodiment, the distal tipportion has a series of annular marks 204 of a first color thatcontrasts with second color of tube 185, wherein the marks are notvisible through the endoscope lens 164 when the microcatheter tube 185is in the non-extended position. After the microcatheter tube 185 isextended into tissue, the marks are visible through the lens 164 whichindicates the tube 185 has been extended into tissue.

Returning now to FIGS. 5 and 6, the cut-away view of the handle portion111 shows the microcatheter member 105 and associated assemblies in thenon-extended position. FIG. 5 shows flanges 208 a and 208 b of cockingactuator 210 are disposed on either side of actuator collar 212 that iscoupled to proximal end 214 of the slidable microcatheter member 105. Ascan be understood from FIG. 5, the downward-extending cocking actuator210 is adapted to cock the flanges 208 a, 208 b and microcatheter 105 toa cocked position which corresponds to the non-extended position of themicrocatheter 105. In FIG. 5, the actuator 210 is shown in a firstposition B (phantom view) and second positions B′ following actuationwith an index finger to thus cock the microcatheter member 105 to thesecond releasable non-extended position (or cocked position) B′ from itsextended position B. The flange 208 a and actuator 210 is further shownin phantom view in the released position indicated at 208 a′. In FIG. 5,the flanges 208 a, 208 b and associated assemblies are configured for anaxial travel range indicated at A that can range from about 8 mm to 15mm which corresponds to the travel of the microcatheter 105 andgenerally to the tissue-penetration depth. In the embodiment of FIG. 5,the flanges 208 a, 208 b and microcatheter member 105 arespring-actuatable to move from the non-extended position to the extendedposition by means of helical spring 215 disposed around sleeve 112. Ascan be seen in FIG. 5, the spring 215 is disposed between the slidableflange 208 b and trigger block 218 that comprises a superior portion ofthe release trigger 220 which is adapted to release the microcatheter105 from its cocked position.

FIG. 5 further illustrates the release trigger 220 releasablymaintaining the flange 205 a and microcatheter 105 in its cockedposition wherein tooth portion 222 of the trigger 220 engages the loweredge of flange 205 a. It can be understood from FIG. 5 that the releasetrigger 220 is configured to flex or pivot around living hinge portion224 when trigger 220 is depressed in the proximal direction by thephysician's finger actuation. After actuation of trigger 220 and releaseof the microcatheter 105 to move distally, the axial travel of theassembly is configured to terminate softly rather than abruptly asflange 208 a contacts at least one bumper element 230 as depicted inFIG. 6. The bumper elements 230 can comprise any spring or elastomericelement, and in FIG. 6 are shown as an elastomer element housed in ahelical spring, which serve to cushion and dampen the end of the travelof the spring-driven microcatheter assembly. The bumper elements 230 arecoupled to flange 235 which in turn is configured to be fixed betweenright- and left-side handle parts 125 a and 125 b (FIG. 4).

Now turning to the energy-delivery aspect of the system, a vapor source250 is provided for delivering a vapor media through the microcathetermember 105 to ablate tissue. The vapor source can be a vapor generatorthat can deliver a vapor media, such as vapor media, that has aprecisely controlled quality to provide a precise amount of thermalenergy delivery, for example measured in calories per second.Descriptions of suitable vapor generators can be found in the followingU.S. patent applications: application Ser. Nos. 11/329,381; 60/929,632;61/066,396; 61/068,049; 61/068,130; 61/123,384; 61/123,412; 61/126,651;61/126,612; 61/126,636; 61/126,620 all of which are incorporated hereinby reference in their entirety. The vapor generation system also cancomprise an inductive heating system similar to that described in U.S.Provisional Application Nos. 61/123,416, 61/123,417, and 61/126,647. Thesystem further includes a controller 255 that can be set to control thevarious parameters of vapor delivery, for example, the controller can beset to delivery vapor media for a selected treatment interval, aselected pressure, or selected vapor quality.

Referring to FIG. 5, in one embodiment, the vapor source 250 is remotefrom the handle 124 and vapor media is carried to the handle by aflexible conduit 262 that couples handle and check valve 264 therein. Inone embodiment, vapor can be re-circulating in conduit 262 until asolenoid in the vapor source is actuated to cause the vapor flow to thusprovide an increased fluid pressure which opens the check valve 265 andallows the vapor media to flow through flexible tube 268 to valve 270that can be finger-actuated by trigger 275. In one embodiment depictedin FIG. 5, the trigger 275 is urged toward a non-depressed position byspring 277 which corresponds to a closed position of valve 270. Thetrigger 275 also can be coupled by an electrical lead (not shown) tocontroller 255. Thus, actuating the trigger 275 can cause the controllerto actuate a solenoid valve in the vapor generator to cause vapor flowthrough the relief valve. As a safety mechanism, the valve 270 in thehandle is opened only by its actuation to thus permit the flow of vapormedia through flexible tube 278 which communicates with inflow portportion 280 of collar 212 which in turn communicates with the lumen 195in the microcatheter 105. Thus, FIG. 5 illustrates the flow path andactuation mechanisms that provide vapor flow on demand from the vaporsource 250 to the vapor outlets 200 in working end 108 of themicrocatheter 105.

As can be seen in FIG. 5, the handle can also provide an interlockmechanism that prevents the actuation of vapor flow if the microcatheterrelease trigger is in the cocked position, wherein edge portion 292coupled to release trigger 220 can engage notch 294 in trigger 275 toprevent depression of said trigger 275.

Still referring to FIG. 5, one embodiment of the system includes a fluidirrigation source 300 that is operatively coupled to the bore 115 inextension member 112 to deliver a fluid outward from the bore 115 to theopen region 162 of the probe working end 145 (see FIG. 8). As can beseen in FIG. 7, the bore 115 is dimensioned to provide a space 138 forfluid irrigation flow around the endoscope 118. In FIG. 5, it can beseen that fluid source 300, which can be a drip bag or controlledpressure source of saline or another fluid, is detachably coupled totubing 302 in the handle which extends to a valve 305 that can bethumb-operated from actuators 308 on either side of the handle. Thethumb actuator 308 also can control the rate of flow of the irrigationfluid by moving the actuator 308 progressively forward, for example, toopen the valve more widely open. The fluid flows from valve 305 throughtube 312 to a port or opening 315 in the extension sleeve 112 to thusenter the bore 115 of the sleeve.

FIG. 5 further depicts an aspiration source 320 operatively coupled totubing 322 in the handle 124 which also can be actuated by valve 305wherein the thumb actuator 308 can be rocked backwardly to allow suctionforces to be applied through the valve 305 to tubing 312 that extends toport 315 in the extension member—which is the same pathway of irrigationflows. Thus, suction or aspiration forces can withdraw fluid from theworking end of the device during a treatment.

Another aspect of one embodiment of probe 100 corresponding to theinvention, referring to FIGS. 4, 5, 6 and 8, is the orientation of themicrocatheter or needle 105 as it exits the working end 145 relative tothe orientation of the pistol grip 124 of the handle portion 111. In amethod use further described below, the introducer will typically beintroduced through the urethra with the pistol grip in a “grip-downward”orientation GD (FIG. 13A) with the pistol grip 126 oriented downwardlywhich comfortable for the physician. The treatment typically willinclude rotationally re-orienting the probe as indicated in FIG. 13A sothat the microcatheter or needle 105 can be penetrated into prostatelobes at 90° to about 135° relative to a grip-downward position. FIGS.13A and 13B are schematic head-on views of the probe 100 in a prostatewith the microcatheter 105 deployed showing the orientation of thehandle pistol grip 124, the deployed microcatheter 105 and the connectorendoscope 136 which indicate the rotational orientation of the endoscope118 and thus the orientation of the camera image on the monitor. As canbe seen in FIGS. 4-6, the assembly of the introducer 110, microcatheter105 and endoscope 118 is rotatable within the handle within flanges 235Aand 235B. In one embodiment, the system has click-stops at variousangles, such as every 15° between 75° and 135° relative to thegrip-downward orientation GD of FIG. 13A. Thus FIGS. 13A-13A and 14A-14Bdepict optional methods that the surgeon may use.

FIGS. 13A and 13B depict the physician locking all components of theprobe 100 in a single rotational orientation, and simply rotating hishand and pistol grip 124 to a selected orientation of greater that 90°from the grip-down position GD, then releasing the microcatheter 105 topenetrate into the prostate lobe. After actuating the vapor deliverytrigger, the vapor ablates regions indicted at 400. It can beappreciated that the endoscope 118 is rotated so that the image on themonitor also is rotated. Thereafter, the physician rotates the probe asdepicted in FIG. 13B to treat the other prostate lobe. This method maybe preferred by physicians that are familiar with anatomical landmarks,opt for simplicity and are accustomed to viewing an image on the monitorwhich is rotated relative a true vertical axis of the patient anatomy.

FIGS. 14A and 14B depict the physician utilizing the rotational featureof the probe and maintaining the handle pistol grip 124 in the grip-downorientation GD and rotating the introducer 110 and microcatheter 105 tothe appropriate angles to treat the first and second lobes of theprostate. This method again is suited for physicians who are familiarwith anatomical landmarks and are accustomed to viewing a rotated imageon the monitor in the OR.

FIGS. 15A and 15B depict the physician utilizing another embodiment of aprobe to treat the two prostate lobes. In the embodiment of FIGS. 5-6,it can be seen that the endoscope 118 is locked in rotationalorientation with introducer 110 and the microcatheter 105—but not withthe handle pistol grip. It can easily be understood that a probe can bemade which allows rotational adjustment between the introducer 110 andmicrocatheter 105 relative to the handle pistol grip 124—but thatprovides a bracket that rotationally locks the endoscope 118 to thehandle pistol grip 124. FIGS. 15A-15B depict the use of such anembodiment, wherein the physician can maintain the handle pistol grip124 in the grip-down orientation GD and then rotates only the introducer110 and microcatheter 105. In this embodiment, the image on the monitorwill remain vertical instead of rotated, which may be preferred byphysicians accustomed to laparoscopy in which images are not rotated onthe monitor when instruments are manipulated.

In another aspect of the invention, referring to FIGS. 10-11, themicrocatheter 105 carries a temperature sensor or thermocouple 405 at adistal location therein, for example as indicated in FIG. 10. Thethermocouple is operatively connected to controller 255 to control vapordelivery. In one embodiment, an algorithm reads an output signal fromthe thermocouple 405 after initiation of vapor delivery by actuation oftrigger 275, and in normal operation the thermocouple will indicate aninstant rise in temperature due to the flow of vapor. In the event, thealgorithm and thermocouple 405 do not indicate a typical rise intemperature upon actuation of trigger 275, then the algorithm canterminate energy delivery as it reflects a system fault that hasprevented energy delivery.

In another embodiment, referring again to FIGS. 10-11, the microcatheter105 can carry another temperature sensor or thermocouple 410 in aportion of microcatheter 105 that resides in passageway 148 of theintroducer body 144. This thermocouple 410 is also operatively connectedto controller 255 and vapor source 250. In one embodiment, an algorithmreads an output signal from thermocouple 410 after initiation of vapordelivery and actuation of actuator 308 that delivers an irrigation fluidfrom source 300 to the working end 145 of the probe. The delivery ofirrigation fluid will maintain the temperature in the region of thethermocouple at a predetermined peak level which will not ablate tissueover a treatment interval, for example below 55° C., below 50° C. orbelow 45° C. If the temperature exceeds the predetermined peak level,the algorithm and controller can terminate vapor energy delivery. Inanother embodiment, a controller algorithm can modulate the rate ofcooling fluid inflows based on the sensed temperature, and/or modulatethe vapor flow in response to the sensed temperature. In an alternativeembodiment, the thermocouple 410 can be in carried in a portion ofintroducer body 144 exposed to passageway 148 in which the microcatheterresides.

Method of Use

Referring to FIGS. 16A and 16B, the device and method of this inventionprovide a precise, controlled thermal ablative treatment of tissue inthe first and second lateral prostate lobes (or right- and left-sidelobes), and additionally an affected median lobe in patients with anenlarged median lobe. In particular, the ablative treatment isconfigured to ablate stromal or smooth muscle tissue, to ablate alphaadrenergic (muscle constriction) receptors, to ablate sympathetic nervestructures, and to ablate vasculature in the treatment zone. Moreparticularly, the method of ablative treatment is configures to targetsmooth muscle tissue, alpha adrenergic receptors, sympathetic nervestructures, and vasculature parallel to the prostatic urethra betweenthe bladder neck region 420 and the verumontanum region 422 as depictedin FIGS. 16A-16B. The targeted ablation regions 425 have a depthindicated at D in FIGS. 16A-16B that is less than 2 cm from theprostatic urethra 120, or less than 1.5 cm. Depending on the length ofthe patient's prostatic urethra 120, the number of ablative energydeliveries can range from 2 to 4 and typically is 2 or 3.

In a method of use, the physician would first prepare the patient fortrans-urethral insertion of the extension portion 110 of the probe 100.In one example, the patient can be administered a mild sedative orallyor sublingually such as Valium, Lorazepam or the like from 15-60 minutesbefore the procedure. Of particular interest, it has been found thatprostate blocks (injections) or other forms of anesthesia are notrequired due to lack of pain associated with an injection of acondensable vapor. The physician then actuates the needle-retractionactuator 210, for example with an index finger, to retract and cock themicrocatheter 105 by axial movement of the actuator (see FIGS. 4-6). Byviewing the handle 124, the physician can observe that the microcatheter105 is cocked by the axial location of trigger 210. A safety lockmechanism (not shown) can be provided to lock the microcatheter 105 inthe cocked position.

Next, the physician advances the extension portion 110 of the probe 100trans-urethrally while viewing the probe insertion on a viewing monitorcoupled to endoscope 118. After navigating beyond the verumontanum 422to the bladder neck 420, the physician will be oriented to theanatomical landmarks. The landmarks and length of the prostatic urethracan be considered relative to a pre-operative plan based on earlierdiagnostic ultrasound images or other images, such as MRI images.

The physician can rotate the microcatheter-carrying probe about its axisto orient the microcatheter at an angle depicted in FIG. 13A to treat afirst lobe. Thereafter, the treatment included cocking and releasing themicrocatheter followed by vapor delivery, the moving and repeating thevapor injection for a total of three (or more) vapor injections in eachlobe. FIG. 17 is a schematic view of a method the invention whereinthree penetrations of the microcatheter 105 are made sequentially in aprostate lobe and wherein energy delivery is provided by vapor energy toproduce slightly overlapping ablations or lesions to ablate the smoothmuscle tissue, alpha adrenergic receptors, and sympathetic nervestructures in a region parallel to the prostatic urethra. The method ofthe invention, when compared to prior art, reduces the burden of ablatedtissue and thus lessens the overall inflammatory response leading tomore rapid tissue resorption and more rapid clinical improvement.

FIG. 18 is a saggital MRI image of an exemplary BPH treatment of apatient 1 week following the procedure, in which the treatment includedthe following steps and energy delivery parameters. The patient'sprostate weighed 44.3 grams based on ultrasound diagnosis. Amparax(Lorazepam) was administered to the patient 30 minutes before theprocedure. In the treatment of the patient in FIG. 18, each treatmentinterval consisted of 10 seconds of vapor delivery at each of sixlocations (3 injections in each lobe). Thus, the total duration ofactual energy delivery was 60 seconds in the right and left prostatelobes. The energy delivered was 24 cal./sec, or 240 cal. per treatmentlocation 425 (FIG. 16A) and a total of 1,440 calories in total to createthe ablation parallel to the prostatic urethra, which can be seen in theMRI of FIG. 18. In the patient relating to the MRI image of FIG. 18, themedian lobe was also treated with a single 10 second injection of vapor,or 240 calories of energy. The vapor can be configured to deliveryenergy in the range of 5 cal./sec. to 100 cal./sec. In general, onemethod includes delivering less than 240 calories of energy to each sitein the prostate.

By comparing the method of the present invention (FIG. 17) with theprior art (FIGS. 3A-3B), it can be understood the method and apparatusof the present invention is substantially different than the prior art.FIG. 3A schematically depicts the prior art RF needle that is elongated,typically at about 20 mm in length, which ablates tissue away from theprostatic urethra and does not target tissue close to and parallel tothe prostatic urethra. Second, the prior art RF energy delivery methodsapply RF energy for 1 to 3 minutes or longer which allows thermaldiffusion of effect to reach the capsule periphery, unlike the veryshort treatment intervals of the method of the present invention whichgreatly limit thermal diffusion. Third, the prior art RF energy deliverymethods do not create a uniform ablation of tissue adjacent and parallelto the prostatic urethra to ablate smooth muscle tissue, alphaadrenergic receptors, and sympathetic nerve structures in a regionparallel to the prostatic urethra.

One method corresponding to the invention is shown in the block diagramof FIG. 19, which includes the steps of advancing a probetrans-urethrally to the patient's prostate, extending a energyapplicator or microcatheter into prostate lobes in a plurality oflocations to a depth of less than 2 cm, and then applying energy at eachlocation to create an ablation zone in a continuous region parallel toat least a portion of the prostatic urethra.

Another method of the invention is shown in the block diagram of FIG.20, which includes the steps of advancing a probe trans-urethrally tothe patient's prostate, extending a energy applicator or microcatheterinto prostate lobes in a plurality of locations, and applying energy ateach location for less than 30 seconds to thereby prevent thermaldiffusion to peripheral portions of the lobes.

Another method of the invention is shown in FIG. 21, which includes thesteps of advancing a probe trans-urethrally to the patient's prostate,extending a energy applicator or microcatheter into prostate lobes in aplurality of locations, and applying energy at each location for aselected interval and irrigating the urethra with a cooling fluidthroughout the selected interval of energy delivery. It has been foundthat such a flow of cooling fluid may be useful, and most important theflow of cooling fluid can be continuous for the duration of thetreatment interval since such times are short, for example 10 to 15seconds. Such a continuous flow method can be used in prior art methods,such as RF ablation methods of FIGS. 3A-3B, since the cooling fluidvolume accumulates in the patient's bladder and the long treatmentintervals would result in the bladder being filled rapidly. This wouldlead to additional steps to withdraw the probe, remove the excess fluidand then re-start the treatment.

FIGS. 22-30 illustrate another probe 500 adapted to deliver condensablevapor to prostate tissue with vapor delivery through a microcatheter orvapor delivery needle as described above. The probe 500 of FIGS. 22-30can be configured with several different systems and mechanisms forvapor generation, vapor delivery, needle actuation, system functioninterlocks and for improved ergonomic function. In FIGS. 22-24, it canbe seen that the probe 500 has a handle portion 504 coupled to elongateintroducer portion 510 that is sized and adapted for insertion into theurethra. The introducer portion 510 can comprise a rigid introducersleeve 512 (shown in FIGS. 27, 30) extending along longitudinal axis 515(FIG. 23) with the introducer portion having a proximal end 518 (FIG.27) and a distal working end 520. FIGS. 27, 29 and 30 illustrate thatsleeve 512 has a lumen 522 therein that is dimensioned to receive anendoscope 525 (see FIGS. 23 and 30). An irrigation source 530communicates with lumen 522 to provide a fluid flow around the endoscopeto exit the working end 520.

In one embodiment, referring to FIGS. 27, 29 and 30, probe 500 includesan extendable-retractable microcatheter or vapor delivery needle 540axially movable in passageway 542 in sleeve 545 that is longitudinallycoupled to sleeve 512. In some embodiments, the microcatheter or needle540 comprises a flexible polymer tube with a sharp tissue piercing tip.In the embodiment of FIGS. 27, 29 and 30, both sleeves 512 and 545 cancomprise thin-wall stainless steel tubes and can be welded together toprovide a rigid structure. Referring to FIG. 30, a polymer surface layer550 can be disposed around the assembly of sleeves 512 and 545, which inone embodiment can comprise a lubricious heat shrink material having awall thickness ranging from 0.005″ to 0.020″.

As can be seen in FIG. 30, the assembly of sleeves 512, 545 and surfacelayer 550 can provide longitudinal air gaps 552 a and 552 b extendingthe length of sleeves 512 and 545. FIGS. 29-30 illustrate that theworking end 520 of introducer portion 510 can comprise a distal body 555of plastic or another suitable material with a blunt nose or tip 556 asdescribed previously for advancing through the patient's urethra. Thedistal body 555 can be configured with side window 560 on either side ofbridge elements 562 and needle window 564 as described in the previousembodiments. In FIGS. 29-30, the distal tip 565 of the microcatheter orneedle 540 is shown locked in the non-extended or retracted position forwhen the physician is navigating the working end 520 of the probe towarda targeted site in the urethra, but which can be released from saidlocked position.

Now turning to FIG. 24, probe 500 can be provided with a vapor generator570 housed with the pistol-grip portion 572 of handle 504. In someembodiments, the vapor generator can be an RF-based induction vaporgenerator. The vapor generator can be housed within the handle of theprobe, as shown, or in other embodiments the vapor generator can beplaced elsewhere within the probe or even external to the probe. Thevapor generator can be coupled to an energy source, such as RF source575 and controller 580.

In one embodiment of an RF-based vapor generator, a RF coil 582 can bepositioned around a helically-wound stainless steel tubing component 584which can be inductively heated by the RF coil 582. The water flow inthe lumen of the helical stainless steel component can be converted tovapor instantly. The controller 580 can be configured to set and controlall functional parameters of the probe, for example, parameters relatingto vapor delivery intervals, pressure in the fluid flow into the vaporgenerator, vapor quality, irrigation flow rates, temperature monitoring,system cooling fans, over-ride mechanisms and the like. In FIG. 24, afluid source 585 can be coupled to inflow line 588 for delivering atreatment fluid or media such as sterile water to the vapor generator570. Referring to FIGS. 24-27, an outflow line 590 adapted to carrycondensable vapor extends upwardly in the handle to flex-loop portion592 that has a termination 594 that connects to a proximal end of theneedle. From FIGS. 25-26, it can be understood that the flex-loopportion 592 of outflow line 590 is configured to accommodate the axialmovement of the vapor delivery needle 540. Referring back to FIG. 24,the RF source 575 is coupled to RF coil 582 of the vapor generator 570by power cord 598.

Now turning to FIGS. 24-28, the sectional and exploded views of thehandle portion 504 and components therein illustrate the microcatheteror vapor delivery needle 540 and the magnetic actuator system that isadapted to move the needle in a distal or extending stroke forpenetrating into tissue. The magnetic system further can be utilized toprovide a proximal or retracting stroke for withdrawing the vapordelivery needle from tissue. FIGS. 26 and 28 show first and secondrotatable blocks 600A and 600B that each carry magnets 602A, 602B withmagnetic poles oriented as shown in FIG. 24. A centralextending-retracting block 610 also carries magnets 612 (see FIG. 25)and is positioned between the first and second rotatable blocks 600A and600B. As can be understood from FIGS. 24-26, the central block 610 iscoupled to the vapor delivery needle and is configured to move distallyand proximally between rotatable blocks 600A and 600B, and is keyed tonot rotate, to thus extend the needle tip out of the working end 520 andto retract the needle tip back into the working end under the influenceof magnetic fields. As also can be understood from FIGS. 24-26, therotation of the first and second rotatable blocks 600A and 600B can movethe magnets 602A, 602B therein (i) into a position that applies forcesupon the magnets 612 in central block 610 or (ii) into a positionwherein the magnets 602A, 602B will be spaced apart from magnets 612 soas to not apply force.

The magnetic actuator system can be configured to advance the vapordelivery needle a predetermined distance. For example, when treatingcertain portions of prostate tissue transurethrally, the magneticactuator system can be configured to advance the vapor delivery needleless than 2 cm from the shaft of the probe into the prostate. Thispredetermined distance can be adjusted prior to therapy so as to ensurethat the needle is placed directly into the proper position within theprostate.

The exploded view of several handle components in FIG. 28 illustrates amagnetic actuator subassembly. A gear rack 620 in the handle 504 isslidable proximally and/or distally when the grip body 622 is moved, forexample, by the physician using his/her fingers or thumbs to engage andmove axially the opposing grip elements 624 a and 624 b. The axialmovement of the gear rack 620 then turns gear 630 which engages androtates the first and second rotatable blocks 600A and 600B that eachcarry magnets 602A, 602B. The movement of the grip 622 further cocks thecentral block 610 into a proximal or retracted position (FIGS. 25-26) atthe same time as it rotates the first and second rotatable blocks 600Aand 600B. The mechanism further has a releasable latch that locks thecentral block 610 and needle 540 in the retracted or non-extendedposition. In this position, the magnets 612 of the central block 610 areoriented directly opposed to the magnets 602A of block 600A and amaximum stored energy is provided in this temporary locked position. InFIG. 28, blocks 600A and 600B and central block 610 are shown spacedapart along longitudinal axis 615.

Needle actuation trigger 635 (FIGS. 24-26) can be actuated to releasethe lock or latch which then allows the stored energy and forces of themagnets 602A and 612 to extend the central block 610 and the vapordelivery needle in its distal stroke. It can be understood that thestored energy or repelling forces of magnets 602A and 612 initiallydrive the central block distally. Further, it can be seen in FIGS. 24-26that the attracting forces of magnets 612 and 602B further drive thecentral block 610 distally. It has been found that the use of bothexpelling and attracting magnetic forces can provide a very high,consistent acceleration and a selected velocity over the extendingstroke of the assembly. In some embodiments, the velocity of the vapordelivery needle in penetrating tissue can range from 0.1 meter persecond to 20.0 meters per second.

FIGS. 24-26 show needle actuation trigger 635 and further show anintegrated actuator 636 which opens and closes an inflow tubing 638coupled to the fluid source 585. As can be seen FIGS. 24-26, a pinchvalve 640 can be actuated by depressing actuator 636—wherein depressingthe actuator 636 causes fluid to be provided under a selected pressureand flow rate through tubing to the endoscope lumen 522. A spring 642urges the actuator toward the non-depressed position. FIGS. 24-26further illustrate that needle trigger 635 and the actuator 636 areintegrated to be operated with a single finger pull. Further, in oneembodiment, the trigger assembly is configured to permit actuation oftrigger 635 only if the irrigation actuator 636 is actuated. Thus, aninterlock can be provided so that irrigation fluid will be flowing intothe urethra to provide for its distension when the needle is releasedand penetrates into tissue.

FIG. 24 further illustrates a vapor actuator or trigger 650 locatedbelow the needle actuation trigger 635. By depressing vapor trigger 650,a electrical switch 652 is actuated which signals the controller 580 tosimultaneously actuate the fluid inflow from fluid source 585 and the RFsource 575 to generate vapor for a treatment interval, which can be from1 to 20 seconds or more as described previously. A typical treatmentinterval can be from 5 to 12 seconds. A spring 654 urges the vaportrigger 650 toward the non-depressed position.

As also can be understood from FIG. 24, another interlock can beprovided between the irrigation fluid actuator 636 and the vapor trigger650 to insure that fluid is flowing into the urethra during the entirevapor delivery interval. This interlock can be useful to dissipate heatfrom sleeve 545 that houses the shaft of the vapor delivery needle 540(see FIG. 30) and to cool and protect the surface of the urethraadjacent the targeted treatment region that is being ablated by thevapor delivery.

FIG. 24 shows that an outflow tubing 660 is provided through the handle504 which is coupled to the endoscope lumen 522. By moving the endoscopeoutwardly through a duckbill seal 662, a reverse flow of fluid from thepatient's bladder can occur which is important for rapidly draining afull patient bladder.

The sectional views of FIGS. 24-27 shows that the handle can compriseright and left-side mating handle parts are coupled to rotatable nosepiece 668 and endoscope adapter 670 to allow independent rotation of theintroducer portion 510 and/or the endoscope adapter 670 and endoscoperelative to the pistol-grip handle portion 572 to provide the freedom ofuse illustrated in FIGS. 13A-13B, 14A-14B, and 15A-15B above.

According to the embodiments described above, a prostate treatmentdevice can be provided comprising an introducer shaft sized andconfigured for transurethral access into a patient, a vapor generatorconfigured to generate a condensable vapor, a vapor delivery needle incommunication with the vapor generator and slidably disposed within theintroducer shaft, and a magnetic actuator configured to apply magneticforce to the vapor delivery needle to move the vapor delivery needlebetween a retracted position inside the introducer shaft and an extendedposition at least partially outside of the introducer shaft.

In some embodiments, the magnetic actuator is configured to axially movethe vapor delivery needle toward the extended position from theretracted position at a velocity ranging from 0.1 meter per second to20.0 meters per second. In another embodiment, the vapor delivery needlecan move between the retracted and extended positions (and vice versa)at a velocity ranging from 1 meter per second to 5 meters per second.

In other embodiments, the magnetic actuator is configured to cause a tipportion of the vapor delivery needle to penetrate into prostate tissuewhen moving toward the extended position from the retracted position. Insome embodiments, the vapor delivery needle is sized and configured toextend into prostate tissue when the introducer shaft is positionedwithin a urethra of the patient.

In one embodiment, the magnetic actuator further comprises a firstmagnet carried by the vapor delivery needle, wherein the magneticactuator is configured to move the first magnet and the vapor deliveryneedle proximally and distally along a longitudinal axis of theintroducer shaft. In another embodiment, the magnetic actuator furthercomprises a second magnet carried in a frame of a handle of the device,the second magnet being configured to interact with the first magnet tomove the vapor delivery needle proximally and distally along thelongitudinal axis of the introducer shaft. In some embodiments, theframe is rotatable in the handle. In yet another embodiment, themagnetic actuator further comprises a third magnet carried in a secondframe of the handle, the third magnet being configured to interact withthe first and second magnets to move the vapor delivery needleproximally and distally along the longitudinal axis of the introducershaft.

In some embodiments, the device can further include a grip adapted formanual control of the magnetic actuator to move the vapor deliveryneedle between the retracted position and the extended position. Inanother embodiment, the device comprises a gear rack coupled to thegrip, the gear rack being configured to rotate the frame and the secondmagnet so as to engage or disengage from the first magnet.

In some embodiments, the device can comprise a lock configured to lockthe vapor delivery needle in the retracted position. The device canfurther comprise a trigger adapted to release the lock to thereby movethe vapor delivery needle to the extended position from the retractedposition.

In one embodiment, the magnetic actuator is configured to apply asuitable magnetic force to cause the tip portion of the vapor deliveryneedle to withdraw from prostate tissue when moving to the retractedposition. In some embodiments, the suitable magnetic force can rangefrom 1 to 3 pounds of force during advancement and retraction. In oneembodiment, the force can be at least 2 pounds of force.

In some embodiments, the device can further include a vapor actuator foractuating a flow of condensable vapor through the vapor delivery needle.The device can further comprise an interlock mechanism which permitsactuation of the vapor actuator only if a releasable lock has beenreleased.

In some embodiments, the magnetic actuator comprises at least one rareearth magnet. In other embodiments, the magnetic actuator comprises atleast one neodymium or neodymium-iron-boron magnet.

In one embodiment, the magnetic actuator orients first and secondmagnets relative to one another to utilize repelling forces to move thevapor delivery needle along a longitudinal axis of the introducer shaft.In another embodiment, the magnetic actuator orients first and secondmagnets relative to one another to utilize attracting forces to move thevapor delivery needle along a longitudinal axis of the introducer shaft.In some embodiments, the magnetic actuator orients first and secondmagnets relative to one another to utilize attracting and repellingforces to move the vapor delivery needle along a longitudinal axis ofthe introducer shaft.

A method of treating prostate tissue is also provided, comprisinginserting a shaft of a prostate therapy device transurethrally until aworking end of the shaft is proximate to the prostate tissue, actuatinga magnetic assembly to advance a vapor delivery needle from theintroducer into the prostate tissue, and delivering condensable vaporfrom the vapor delivery needle into the prostate tissue.

In some embodiments, the condensable vapor provides a thermal effect inthe prostate tissue.

In one embodiment, the vapor delivery needle advances into the prostatetissue under the influence of repelling forces between first and secondmagnets of the magnetic assembly. In another embodiment, the vapordelivery needle advances into the prostate tissue under the influence ofattracting forces between first and second magnets of the magneticassembly. In some embodiments, the vapor delivery needle advances intothe prostate tissue under the influence of attracting and repellingforces between first and second magnets of the magnetic assembly.

A prostate treatment device is also provided, comprising an introducershaft sized and configured for transurethral access into a patient, avapor generator configured to generate a condensable vapor, a vapordelivery needle in communication with the vapor generator and slidablydisposed within the introducer shaft, and an actuation mechanismconfigured to apply force to move a distal portion of the vapor deliveryneedle from a retracted position inside the introducer shaft to anextended position outside of the introducer shaft.

In some embodiments, the actuation mechanism moves a distal tip of thevapor delivery needle outward from the introducer shaft a distance ofless than 2 cm.

In another embodiment, the device comprises a controller configured todeliver a selected volume of condensable vapor through the needle thatcarries less than 240 calories of energy.

In some embodiments, the actuation mechanism comprises a spring. Inother embodiments, the actuation mechanism comprises at least onemagnet. In one embodiment, the actuation mechanism is configured to movethe vapor delivery needle toward the extended position from theretracted position at a velocity ranging from 0.1 meter per second to20.0 meters per second.

In one embodiment, the vapor delivery needle is sized and configured toextend into prostate tissue when the introducer shaft is positionedwithin a urethra of the patient.

In some embodiments, the actuation mechanism comprises a first magnetcarried by the vapor delivery needle. In another embodiment, theactuation mechanism comprises a second magnet carried in a frame of ahandle of the device, the second magnet being configured to interactwith the first magnet to move the vapor delivery needle. In someembodiments, the frame is rotatable in the handle.

In some embodiments, the device can further include a grip adapted formanual control of the magnetic actuator to move the vapor deliveryneedle between the retracted position and the extended position. Inanother embodiment, the device comprises a gear rack coupled to thegrip, the gear rack being configured to rotate the frame and the secondmagnet so as to engage or disengage from the first magnet.

In some embodiments, the device can comprise a lock configured to lockthe vapor delivery needle in the retracted position. The device canfurther comprise a trigger adapted to release the lock to thereby movethe vapor delivery needle to the extended position from the retractedposition.

In some embodiments, the device can further include a vapor actuator foractuating a flow of condensable vapor through the vapor delivery needle.The device can further comprise an interlock mechanism which permitsactuation of the vapor actuator only if a releasable lock has beenreleased.

A method of treating prostate tissue is provided, comprising inserting ashaft of a prostate therapy device transurethrally until a working endof the shaft is proximate to the prostate tissue, advancing a vapordelivery needle from the introducer into at least one site in prostatetissue to a depth of less than 2 cm, and delivering condensable vaporfrom the vapor delivery needle into the prostate tissue.

In some embodiments, the condensable vapor provides a thermal effect inthe prostate tissue. In other embodiments, the condensable vapordelivers less than 240 calories of energy at each site.

In one embodiment, the vapor delivery needle advances into the prostatetissue under forces applied by a spring. In another embodiment, thevapor delivery needle advances into the prostate tissue under theinfluence of at least one magnet.

Although particular embodiments of the present invention have beendescribed above in detail, it will be understood that this descriptionis merely for purposes of illustration and the above description of theinvention is not exhaustive. Specific features of the invention areshown in some drawings and not in others, and this is for convenienceonly and any feature may be combined with another in accordance with theinvention. A number of variations and alternatives will be apparent toone having ordinary skills in the art. Such alternatives and variationsare intended to be included within the scope of the claims. Particularfeatures that are presented in dependent claims can be combined and fallwithin the scope of the invention. The invention also encompassesembodiments as if dependent claims were alternatively written in amultiple dependent claim format with reference to other independentclaims.

What is claimed is:
 1. A prostate treatment device, comprising: anintroducer shaft sized and configured for transurethral access into apatient; a vapor generator configured to generate a condensable vapor; avapor delivery needle in communication with the vapor generator andslidably disposed within the introducer shaft; a first magnet coupled tothe vapor delivery needle, wherein the first magnet is configured tomove distally relative to the introducer shaft; and a second magnetconfigured to rotate about the first magnet so as to apply a magneticforce to the first magnet in order to move the vapor delivery needlebetween a retracted position, in which the vapor delivery needle isinside the introducer shaft, and an extended position, in which thevapor delivery needle is at least partially outside of the introducershaft.
 2. The device of claim 1, wherein the magnetic force isconfigured to move the vapor delivery needle toward the extendedposition from the retracted position at a velocity ranging from 0.1meters per second to 20.0 meters per second.
 3. The device of claim 1,wherein the magnetic force is configured to cause a tip portion of thevapor delivery needle to penetrate into prostate tissue when movingtoward the extended position from the retracted position.
 4. The deviceof claim 1, wherein the vapor delivery needle is sized and configured toextend into prostate tissue in configurations in which the introducershaft is positioned within a urethra of the patient.
 5. The device ofclaim 1, further comprising a third magnet configured to rotate aboutthe first magnet, wherein a rotation of the second and third magnetsrelative to the first magnet applies a force upon the first magnet inorder to move the vapor delivery needle distally or proximally betweenthe second magnet and the third magnet.
 6. The device of claim 1,further comprising a grip adapted to control the second magnet.
 7. Thedevice of claim 1, further comprising a lock configured to lock thevapor delivery needle in the retracted position.
 8. The device of claim7, further comprising a trigger adapted to release the lock to therebymove the vapor delivery needle to the extended position from theretracted position.
 9. The device of claim 1, further comprising a vaporactuator for actuating a flow of condensable vapor through the vapordelivery needle.
 10. A prostate treatment device, comprising: anintroducer shaft sized and configured for transurethral access into apatient; a vapor generator configured to generate a condensable vapor; avapor delivery needle in communication with the vapor generator andslidably disposed within the introducer shaft; a first permanent magnetcoupled to the vapor delivery needle, wherein the first permanent magnetis configured to move distally relative to the introducer shaft; and asecond permanent magnet configured to apply a magnetic force to thefirst magnet in order to move the vapor delivery needle between aretracted position, in which the vapor delivery needle is inside theintroducer shaft and an extended position, in which the vapor deliveryneedle is at least partially outside of the introducer shaft.
 11. Thedevice of claim 10, wherein the magnetic force configured to move thevapor delivery needle toward the extended position from the retractedposition at a velocity ranging from 0.1 meters per second to 20.0 metersper second.
 12. The device of claim 10, wherein the magnetic force is afirst magnetic force, the device further comprising a third permanentmagnet configured to apply a second magnetic force in order to move thevapor delivery needle between the retracted position and the extendedposition.
 13. The device of claim 12, wherein the second magnet and thethird magnet are configured to rotate about the first magnet.
 14. Thedevice of claim 13, wherein the first magnetic force and the secondmagnetic force are operative to move the vapor delivery needle distallyor proximally between the second magnet and the third magnet.
 15. Thedevice of claim 10, further comprising a grip adapted to control thesecond magnet.
 16. A prostate treatment device, comprising: anintroducer shaft sized and configured for transurethral access into apatient; a handle at a proximal end of the introducer shaft; a vaporgenerator configured to generate a condensable vapor; a vapor deliveryneedle in communication with the vapor generator and slidably disposedwithin the handle and the introducer shaft; a first magnet disposed inthe handle and coupled to the vapor delivery needle, wherein the firstmagnet is configured to move distally relative to the handle and theintroducer shaft; and a second magnet disposed in the handle andconfigured to apply a magnetic force to the first magnet in order tomove the vapor delivery needle between a retracted position, in whichthe vapor delivery needle is inside the introducer shaft and an extendedposition, in which the vapor delivery needle is at least partiallyoutside of the introducer shaft.
 17. The device of claim 16, wherein thehandle includes a pistol grip.
 18. The device of claim 17, wherein thehandle further includes a trigger, and wherein depression of the triggeris configured to rotate the second magnet relative to the first magnet.19. The device of claim 16, wherein each of the first magnet and thesecond magnet is a permanent magnet.
 20. The device of claim 16, whereinthe force is a first force, the device further comprising a third magnetdisposed in the handle and configured to apply a second magnetic forceto the first magnet in order to move the vapor delivery needle betweenthe retracted position and the extended position.